My pills cost $312 a month. My check is $1,540. So I started cutting the little white ones in half, then in quarters, and telling my doctor I felt fine. I did that for eight months.

There is a strange sort of arithmetic that takes over when you are old and the numbers do not line up anymore. At first, you look at the rent, the electricity, the rising cost of groceries, and you try to trim the edges. You turn off the heat in the back bedroom. You buy the store-brand bread instead of the one you like. But rent does not bend, and utility companies do not care if your bones ache. The pharmacy, however, stands there every thirty days with its hand out, and that is where the math finally breaks.

My blood pressure medication was the anchor holding the whole fragile ship together, or so the doctor told me when he wrote the script. Two small white tablets a day, morning and evening, to keep the pipes from bursting. But three hundred and twelve dollars out of fifteen hundred and forty leaves you with very little room for things like shoes that do not leak or a tank of heating oil when the wind turns sharp.

I remember sitting at the kitchen table on a Tuesday morning in early spring when I made the choice. The sun was coming through the window, dusty and weak, illuminating the stack of envelopes I had pushed into the corner.

I had already sold the good silver tea set to a dealer down on Elm Street three months before, getting far less than it was worth because I was tired and my knees hurt from walking there.

“You need to take these every day without fail,” Dr. Harrison had told me, his pen poised above the pad. “We cannot afford any fluctuations.”

“I understand,” I had said, smiling the polite smile that doctors expect from old women who nod at everything.

So I went home and took a sharp kitchen knife to the first little white pill. It crumbled a bit at the edges, sending white dust across the yellow formica. I licked my finger and pressed it to the stray bits, swallowing them anyway, because nothing could be wasted. A half pill in the morning, a quarter in the evening. By the second month, I had figured out how to make a thirty-day supply stretch for sixty, and eventually, through sheer stubborn calculation, I stretched them even further.

Every time I went back for my refill, I practiced my lines in the car before walking through the automatic doors. I would smooth down my cardigan, check my purse, and practice looking sturdy.

“How are we feeling today?” the pharmacist would ask, scanning the orange bottle.

“Just fine,” I always told him. “Everything seems to be working as it should.”

“Blood pressure holding steady?”

“Right where it needs to be,” I would say, meeting his eyes just enough to seem honest, but not long enough for him to see the tiredness humming behind them.

Then I would walk out to my old car, put it in drive, and head home to the silence. For eight months, that was my life. I kept the curtains drawn a little tighter. I stopped going to the Wednesday morning coffee club at the community center because people asked too many questions about why I looked so pale or why my hands shook when I poured the creamer. I told them it was just the damp weather in my joints.

When my daughter called on Sundays, I kept the conversations short.

“How are you holding up, Mom?” she would ask, her voice tinny and distant through the receiver.

“I am doing just fine, honey. Keeping busy around the house,” I would say, staring at the dust motes dancing in the hallway.

“Did you get your groceries delivered?”

“Yes, everything is taken care of.”

“You sound tired.”

“Just getting older, that is all. How are the kids?”

That usually worked. She had her own life, three towns over, with a mortgage and a husband who traveled for work and two teenagers who ate through the pantry like locusts. She did not need to know that I was living on tea, toast, and fractions of medicine, playing a slow game of chicken with my own cardiovascular system.

Last Tuesday, however, the arithmetic caught up with me. My grandson stayed over. He is twelve, and he counts everything, that boy. He has a mind like a cash register, always adding up scores, measuring distances, noticing when a single book is out of place on the shelf.

He arrived right around four o’clock, dumping his backpack by the front door with a heavy thud that rattled the umbrella stand.

“Grandma, can I have some apple juice?” he asked, already heading for the kitchen before I could answer.

“Of course, Leo. There is some in the pitcher,” I said, leaning against the counter to steady myself.

My chest had been tight for a week, an ache I kept calling heartburn, blaming it on the spicy soup I had made on Sunday.

He poured his juice, took a long drink, and then his eyes drifted over to the windowsill where I had left my pill bottles. I usually kept them tucked away in the bathroom cabinet, but I had refilled the prescription that morning and had not yet put the new bottle away.

Leo walked over, picked up the orange cylinder, and turned it over in his hand. Then he looked at the open bottle next to it, the one with the halved and quartered tablets sitting on a small paper towel like fragments of chalk.

He lined my pill bottles up on the counter and did the arithmetic out loud. “Grandma, there’s supposed to be sixty. There’s a hundred forty.”

I tried to laugh, but it came out sounding like a dry cough. “Oh, Leo, you know how pharmacies are. They make mistakes all the time with counts.”

“No, they don’t,” he said, not looking up at me. His brow was furrowed in that intense way his father gets when he is balancing the tax forms. “The label says thirty-day supply, and it’s been refilled four months ago, but you’ve got bottles piling up. And these ones are cut in half.”

He looked at the halves, then at me.

“Leo, put those down, let’s go watch, “

“Why are they cut, Grandma?”

My chest had been tight for a week, an ache I kept calling heartburn. The kitchen light seemed to grow very bright, flickering at the edges of my vision like a dying bulb.

I opened my mouth to explain, and the kitchen floor came up to meet me.

The fall was surprisingly quiet. There was no dramatic crash, no shattering of dishes, just a sudden tipping of the world until the yellow formica rushed up to fill my eyes. I remember the cold feel of the linoleum against my cheek and the sound of Leo shouting my name, his voice cracking with a sudden, sharp terror that sounded far too small for the kitchen.

“Grandma? Grandma, get up. Stop joking around.”

I tried to answer him, but my tongue felt heavy and dry, like a piece of salted wood. My chest felt as though someone had placed a heavy flatiron right over my ribs and was leaning down with all their weight.

“Grandma!”

His footsteps raced away toward the hallway, and then I heard the sharp, frantic tapping of buttons on the landline phone. I could hear his voice, high and thin, talking to someone far away, explaining where we were, telling them that I had fallen down and would not wake up.

Lying there on the floor, staring sideways at the base of the kitchen cabinets where a stray crumb of bread had sat unnoticed since Sunday, I felt a strange sense of relief wash through the tightness in my chest. The secret was out. The endless math, the careful cutting of the little white tablets, the eight months of pretending I was stronger than my own budget, it was all finished.

The sound of a siren began to wail somewhere down the street, growing louder as it turned onto our block, its red light washing in through the living room windows and painting the walls in slow, rhythmic sweeps. Leo appeared back in the doorway, dropping to his knees beside me, his small hand reaching out to grab mine with a grip that was fierce and warm.

“They’re coming, Grandma. They’re almost here,” he whispered, his face hovering just above mine, wet with tears he was trying hard not to let fall.

I squeezed his fingers back as best I could, letting my eyes close against the flashing red light, finally letting someone else do the counting.